Liao Yu-Sheng, Zhao Qiu, Fan Yan, Wu Jie
Department of Gastroenterology, Central Hospital, Wuhan, China.
Niger J Clin Pract. 2014 May-Jun;17(3):384-6. doi: 10.4103/1119-3077.130253.
Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the incidence of post-ERCP pancreatitis and facilitate bilitary cannulation in difficult cases. Proximal migration of a pancreatic stent during bile duct stone extraction is an infrequent event, but its management can be technically challenging. We present a case that a double flanged pancreatic stent (5 French (Fr), 5 cm) was placed to facilitate the bilitary cannulation during the bile duct stone extraction. The pancreatic duct stent migrated into the proximal pancreas duct at the end of the bile duct stone clearance. After two unsuccessful attempts to remove the impacted stent with a balloon catheter and forceps, wire-guided endoscopic snare retrieval was conducted. Firstly, a guide wire was placed in the pancreatic duct and a soft mini-snare was passed over the guide wire. Then, the mini-snare was advanced into the proximal pancreatic duct over the guide wire and the proximally migrated stent was removed successfully with the mini-snare. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents is safe and effective. The successful case of the retrieval with mini-snare provides another option for proximal migration retrieval of pancreatic stent retrieval. Further studies are needed to confirm its effectiveness and elucidate its associated complications.
在治疗性内镜逆行胰胆管造影术（ERCP）期间，胰管支架用于多种情况。胰管支架置入可降低ERCP术后胰腺炎的发生率，并有助于困难病例中的胆管插管。在胆管结石取出过程中，胰管支架向近端移位是一种罕见事件，但其处理在技术上可能具有挑战性。我们报告一例在胆管结石取出过程中放置双法兰胰管支架（5法式（Fr），5厘米）以促进胆管插管的病例。在胆管结石清除结束时，胰管支架移入近端胰管。在用球囊导管和镊子取出嵌顿支架的两次尝试失败后，进行了导丝引导下的内镜圈套器取出术。首先，将一根导丝置入胰管，然后将一个软质微型圈套器套在导丝上。接着，将微型圈套器沿导丝推进至近端胰管，并用微型圈套器成功取出向近端移位的支架。导丝引导下的内镜圈套器取出向近端移位的胰管支架是安全有效的。用微型圈套器成功取出的病例为胰管支架近端移位取出提供了另一种选择。需要进一步研究以证实其有效性并阐明其相关并发症。
